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Introduction: Acetabular fracture subtypes are associated with varying rates of subsequent conversion total hip arthroplasty (THA) after open reduction internal fixation (ORIF) with transverse posterior wall (TPW) patterns having a higher risk for early conversion. Conversion THA is fraught with complications including increased rates of revision and periprosthetic joint infections (PJI). We aimed to determine if TPW pattern is associated with higher rates of readmissions and complications including PJI after conversion compared to other subtypes., Methods: We retrospectively reviewed 1,938 acetabular fractures treated with ORIF at our institution from 2005 to 2019, of which 170 underwent conversion that met inclusion criteria, including 80 TPW fracture pattern. Conversion THA outcomes were compared by initial fracture pattern. There was no difference between the TPW and other fracture patterns in age, BMI, comorbidities, surgical variables, length of stay, ICU stay, discharge disposition, or hospital acquired complications related to their initial ORIF procedure. Multivariable analysis was performed to identify independent risk factors for PJI at both 90-days and 1-year after conversion., Results: TPW fracture had higher risk of PJI after conversion THA at 1-year (16.3% vs 5.6%, p = 0.027). Multivariable analysis revealed TPW independently carried increased risk of 90-day (OR 4.89; 95% CI 1.16-20.52; p = 0.03) and 1-year PJI (OR 6.51; 95% CI 1.56-27.16; p = 0.01) compared to the other acetabular fracture patterns. There was no difference between the fracture cohorts in 90-day or 1-year mechanical complications including dislocation, periprosthetic fracture and revision THA for aseptic etiologies, or 90-day all-cause readmission after the conversion procedure., Conclusion: Although conversion THA after acetabular ORIF carry high rates of PJI overall, TPW fractures are associated with increased risk for PJI after conversion compared to other fracture patterns at 1-year follow-up. Novel management/treatment of these patients either at the time of ORIF and/or conversion THA procedure are needed to reduce PJI rates., Level of Evidence: Therapeutic Level III (retrospective study of consecutive patients undergoing an intervention with analyses of outcomes)., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Purpose: To compare the ocular comfort at application of topical, over-the-counter, 0.7% olopatadine and 0.035% ketotifen fumarate anti-allergy eye drops., Methods: This study recruited participants who were minimally symptomatic based upon Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire scores (≤3 units) and who had minimal between-eye inter-ocular comfort differences as judged by visual analog scale scores (VAS; ≤7 units). Baseline comfort was evaluated by eye with a VAS. One drop of 0.7% olopatadine or 0.035% ketotifen fumarate was then applied to the right eye with the alternative drop being immediately applied to the left eye. Participants were next evaluated with the same comfort VAS by eye at drop application, and then at 30 s, 1 min, and 2 min post-application. LogMAR visual acuities and bulbar conjunctival redness were evaluated pre- and post-drop application to judge initial changes., Results: This study enrolled 159 participants who had a mean ± SD age of 26.3 ± 7.7 years, and 78.6% of the participants were female. The VAS found that the 0.7% olopatadine drop was more comfortable than the 0.035% ketotifen fumarate drop at all time-points. There were no between-eye differences in LogMAR visual acuities, yet bulbar redness was significantly less in 0.7% olopatadine treated eyes compared 0.035% ketotifen fumarate treated eyes., Conclusion: This study found that topically applied 0.7% olopatadine drops were initially more comfortable than 0.035% ketotifen fumarate drops., Competing Interests: Declaration of Competing Interest The authors have received research support from Abbvie Pharmaceuticals (CH, LRK, MC, RB, CL), Alcon Research, LLC (All), Allergan (CL, CH, MC, RB), Art Optical (ADP), Bausch & Lomb (ADP), Euclid Systems (ADP), Contamac (ADP), and National Eye Institute (ADP), and consultant for Alcon Research, LLC (ADP), Allergan (CL, CH, MC, RB), CooperVision (ADP), EpiTech (ADP), EyeGate Pharmaceuticals, Inc (ADP), Kala Pharmaceuticals (ADP), MacuLogix (CL), Nevakar Inc (ADP), Optikal Care Inc (ADP), RVL Pharmaceuticals, Inc (CL), Transitions (CL), and Transitions Optical (CL) over the past three years., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: To evaluate the epidemiologic association between visual acuity and other measures of visual function and motor vehicle collisions (MVCs) as well as their performance as screening tests for MVCs., Design: Prospective cohort study., Participants: A total of 2000 licensed drivers aged 70 years and older who resided in the environs of Jefferson County, Alabama., Methods: Visual acuity, contrast sensitivity, useful field of view, Motor-free Visual Perception Test, and visual field sensitivity were measured at a baseline visit. Study participants were followed for up to 4 years for the occurrence of MVC involvement. Area under the curve (AUC), sensitivity, and specificity were calculated to determine the screening performance of each visual function measure with respect to MVC occurrence. Poisson regression was used to estimate rate ratios (RRs) for the association between each visual function measure and MVC occurrence., Main Outcome Measures: Police-reported MVCs., Results: For all visual function measures, the AUC values were only slightly higher than 0.50; additionally, none of the measures exhibited adequate values for both sensitivity and specificity (i.e., > 80%). For all visual function measures except visual acuity, there were statistically significant positive RRs for the association between vision impairment and MVC occurrence, although the magnitude of the associations was weak (i.e., < 2.0)., Conclusions: The negative impact of involuntary driving cessation on mobility and the associated mental health implications likely outweigh the safety benefit of vision screening. Alternative approaches to improving older driver safety should be considered., (Copyright © 2022 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Background: Preoperative treatment recommendations and optimal time to perform total joint arthroplasty (TJA) in patients with hepatitis C virus after treatment completion for achieving best outcomes have not been elucidated. We aim to determine (1) if undetectable viral load (UVL) prior to TJA leads to decreased postoperative complication rates, specifically periprosthetic joint infection (PJI), and (2) if delaying TJA after treatment completion has benefit in decreasing PJI., Methods: A retrospective review of all hepatitis C virus patients undergoing TJA at 3 academic tertiary care centers was conducted. A total of 270 TJAs performed from 2005 to 2019 were included, 125 with positive viral load at the time of surgery. The duration from completion of treatment regimen to TJA was recorded for the UVL cohort. The primary study outcome was PJI at 1-year follow-up. Secondary outcomes included in-hospital complications, mechanical revision TJA rates, and optimal time to TJA upon completion of treatment., Results: Patients with positive viral load at the time of TJA had longer length of stay (3.9 vs 2.9 days, P  < .0001) and a higher PJI rate at 1 year postoperatively (9% vs 2%, P  = .02) than UVL patients. There was no difference of in-hospital complications or revision rates for mechanical etiologies. Delaying TJA after achieving a sustained virologic response did not impact PJI rates., Conclusions: Sustained UVL prior to TJA is critical to minimize PJI irrespective of the treatment regimen utilized. Surgery can be performed with lower complication rates any time after achieving sustained virologic response., Level of Evidence: Level III, prognostic retrospective cohort study., (© 2022 The Authors.)

Purpose: To understand the safety of treating contact lens (CL) discomfort with a new artificial tear when it is directly applied to a CL-wearing eye., Methods: This was a two-week, two-visit, double-masked study that randomized participants with CL discomfort to use Systane Complete (artificial tear), Sensitive Eyes (rewetting drop), or no treatment. Drops were applied before, twice during, and after CL use each day. Corneal staining served as the primary safety metric. Conjunctival staining, tear break-up time, Schirmer's test, CL comfort (Contact Lens Dry Eye Questionnaire-8 [CLDEQ-8]), and dry eye symptoms (Standardized Patient Evaluation of Eye Dryness [SPEED]) were also evaluated., Results: This study recruited 73 participants with a mean age of 30.3 ± 11.5 years; 18 % of the participants were male. There were no significant changes in ocular surface signs from baseline or between the artificial tear and rewetting drop groups after two weeks (p ≥ 0.05). Participants in the artificial tear and rewetting drop groups had significant improvements in CLDEQ-8 scores after two weeks of treatment compared with baseline (p < 0.0001), though scores for this test were not significantly different between these groups after two weeks (p = 0.94). CLDEQ-8 scores were significantly better in the artificial tear and rewetting drop groups compared with no treatment after two weeks (p < 0.0001)., Conclusions: Both drops were found to be safe for use with CLs while also significantly improving ocular symptoms compared to no treatment after two weeks of use., (Copyright © 2020 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Objectives: Residents receiving industry payments are not legally required to be reported on the Centers for Medicare & Medicaid Services (CMS) Open Payments Database. The purpose of this study is to review reporting of orthopedic surgery residents and identify the trends for which payments or transfers in value were received., Design: The CMS Open Payments Database was used to search for all available orthopedic residents from 2014 to 2016. All data available on the CMS Open Payments Database was recorded., Setting/participants: This is a database study. Participants are residents reported in the CMS Open Payments Database., Results: Over the 3-year period, 6832 resident "entities" were identified from 151 programs. A total of 3217 entities (47%) were reported as receiving payments from industry during this time period. This totaled $3,786,754 over the 3 year study period. The largest itemized categories for payment were education (32.5%) and grants (30.9%) totaling more than $2.4 million. Other areas of payment included travel (17.0%), food (16.0%), consultation fee (1.7%), research (0.8%), speaker fee (0.7%), gift (0.1%), honoraria (0.1%), and other (0.02%)., Conclusion: Overall, 47% of orthopedic resident entities were reported on the CMS Open Payments Database. The vast majority of payments were related to education and grants. Residents should become familiar with how to navigate the Open Payments Database and be educated on maintaining appropriate relationships with industry., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Purpose: To understand if a new artificial tear, which is indicated for the treatment of both evaporative and aqueous deficient dry eye, is able to safely alleviate contact lens discomfort (CLD) in symptomatic soft contact lens (CL) wearers., Methods: This registered, investigator-masked, two-week, randomized clinical trial recruited adult subjects with symptomatic Contact Lens Dry Eye Questionanire-8 (CLDEQ-8 scores ≥ 12) scores. Subjects were randomized to use artificial tears (Systane Complete) before and after CL use or no treatment. Clinical signs (visual acuity, tear breakup time, corneal staining, Schirmer's test I, and meibum quality and expression) and symptoms (CLDEQ-8, Standardized Patient Evaluation of Eye Dryness (SPEED), self-reported) were evaluated at baseline and two weeks., Results: This study recruited 22 subjects who were randomized to artificial tears and 24 subjects who were randomized to no treatment. Subjects in the artificial tears group had significantly better CLDEQ-8 scores (12.86 ± 6.40 vs. 17.92 ± 5.30; p = 0.006) but not SPEED scores (7.55 ± 4.31 vs. 9.29 ± 4.14; p = 0.17) at two weeks compared to the no treatment group. No significant between group differences were noted for any clinical signs at two weeks (all p > 0.29). No subject in either group reported any adverse events during the study., Conclusions: Systane Complete was found to safely and significantly improve CL comfort in symptomatic CL wearers. Additional work is needed to better understand the mechanism(s) leading to improved comfort since tested clinical signs were unchanged., (Copyright © 2019 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Introduction: Risk factors associated with various adverse outcomes for patients undergoing open reduction and internal fixation (ORIF) of the ankle, and how these risks differ between younger and older patient populations, has not been clearly established. Objective quantitative data may aid physicians in surgical decision making, individualizing postoperative management, and targeting interventions for reducing postoperative comorbidity. The purpose of this study is to compare the incidence of and risk factors for adverse postoperative outcomes following ORIF of ankle fractures across patient age groups., Materials and Methods: Charts of patients age 18 years and older who underwent open reduction and internal fixation (ORIF) for any closed, non-polytraumatic, non-pilon ankle fracture at a single institution between the years 2008 and 2018 were reviewed. Demographic information, comorbidities, and postoperative outcomes were collected. Relative risks for adverse outcomes were calculated and compared between patients younger than 50 and patients 50 years and older., Results: A total of 886 patients were included, 375 (42.3%) of which were over age 50. In both age groups, risk of infection was significantly increased among patients with hypertension, although risk among older patients (RR = 3.52, p = 0.004) was greater than that among younger patients (RR = 2.46, p = 0.017). In patients younger than 50, significant risk of wound dehiscence was associated with tobacco use (RR = 3.39, p = 0.022), substance use (RR = 3.07, p = 0.020), and CHF (RR = 12.77, p < 0.001). Risk of implant failure was significantly increased among younger patients with HIV (RR = 4.33, p = 0.026), CHF (RR = 10.54, p < 0.001), and CKD (RR = 10.54, p < 0.001), and among older patients with HTN (RR = 4.51, p = 0.006), CHF (RR = 5.83, p < 0.001), and tobacco use (RR = 3.82, P = 0.001)., Conclusion: Patients undergoing ORIF of the ankle should be well-informed of the potential risks of surgery as they pertain to specific comorbidities. Multidisciplinary approaches are warranted for appropriate management of patients with multiple comorbidities., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Evidence suggests that GABA may reduce pancreatic inflammation, protect β-cells from autoimmune destruction, and potentiate the regeneration of new β-cells in the setting of type 1 diabetes mellitus (T1DM). The enzyme GAD, also expressed in human pancreatic β-cells, is an antigenic target of reactive T cells. We hypothesized that treatment of children with recent onset T1DM with GABA or combination GABA with GAD will preserve β-cell function and ameliorate autoimmune dysregulation., Methods: This is a one-year, prospective, randomized, double-blind, placebo-controlled trial. Ninety-nine patients aged 4-18 years with newly diagnosed T1DM are randomized into three treatment groups: 1) oral GABA twice daily in addition to two injections of recombinant GAD enzyme, 2) oral GABA plus placebo GAD injections, or 3) placebo GABA and placebo GAD. Patients are evaluated at baseline and months 1, 5, 8 and 12. Mixed meal tolerance testing is performed at all but the 8-month visit. Laboratory studies will assess indices of beta and alpha cell function, glycemic control, immunophenotyping, and diabetes-related autoantibodies., Results: The primary outcome is the effect on pancreatic β-cell function as measured by meal-stimulated c-peptide secretion compared between the treatment groups before and after one year of treatment. Secondary outcomes include: 1) fasting and meal stimulated glucagon and proinsulin levels, 2) response in insulin usage by participants, 3) indices of immune cell function, and 4) effect on autoantibodies GAD65, ICA512, and ZnT8., Conclusions: This trial will determine the safety and efficacy of GABA and combination GABA/GAD therapy to delay T1DM progression in children., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Purpose: To examine the association between sequence variants in genetic risk factors for age-related macular degeneration (AMD) and delayed rod-mediated dark adaptation (RMDA), the first functional biomarker for incident AMD, in older adults with normal macular health and early AMD., Design: Cross-sectional., Participants: Adults 60 years of age or older showing normal macular health (defined as both eyes at step 1 on the Age-Related Eye Disease Study 9-step AMD classification system) and those with AMD in one or both eyes (defined as steps 2-9)., Methods: Single nucleotide polymorphisms were genotyped in the complement factor H (CFH) and ARMS2 genes using a Taqman assay. Rod-mediated dark adaptation was assessed in 1 eye after photobleach with targets centered at 5° on the inferior vertical meridian. Rate of dark adaptation was defined by rod intercept time (RIT), duration (in minutes) required for sensitivity to reach a criterion sensitivity level in the latter half of the second component of rod recovery. Associations between CFH and ARMS2 polymorphisms and RMDA were adjusted for age and smoking., Main Outcome Measure: Rod intercept time., Results: The sample consisted of 543 participants having both genotype and RIT determination; 408 showed normal macular health and 135 demonstrated AMD, most having early AMD (124 of 135). For the combined sample, higher RIT (slower RMDA) was observed for both the A69S variant in ARMS2 and the Y402H variant in CFH (adjusted P = 0.0001 and P = 0.0023, respectively). For healthy participants, the A69S variant in ARMS2 was associated with higher RIT (adjusted P = 0.0011), whereas the Y402H variant in CFH was not (adjusted P = 0.2175). For AMD patients, the A69S variant of ARMS2 and the Y402H variant of CFH were associated with higher RIT (adjusted P = 0.0182 and P = 0.0222, respectively). Those with a larger number of high-risk ARMS2 and CFH alleles showed higher RIT, in both healthy and AMD groups (adjusted P = 0.0002 and P < 0.0001, respectively)., Conclusions: We report a novel association wherein older adults with high-risk ARMS2 and CFH genotypes are more likely to demonstrate delayed RMDA, the first functional biomarker for incident early AMD. Before the AMD clinical phenotype is present, those showing normal macular health with the ARMS2 A69S allele demonstrate delayed RMDA. Understanding ARMS2 function is a research priority., (Copyright © 2018 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Introduction: Hip fractures and metabolic syndrome (MetS) are becoming major global healthcare burdens as populations age. This study sought to determine the impact of MetS in hip fracture patients on perioperative outcomes following operative fixation or arthroplasty., Methods: Data from the 2004-2014 Nationwide Inpatient Sample was used to select 3,348,207 discharges with hip fracture. MetS patients were identified by having at least 3 of 4 component comorbidities: hypertension, dyslipidemia, obesity, and diabetes. Logistic regression was used to estimate odds ratios for the association between MetS and perioperative outcomes adjusted for age, gender, race, payer status, and comorbidities., Results: Overall, 32% of hip fracture patients were treated with open reduction internal fixation (ORIF), 28% hemiarthroplasty (HA), 18% closed reduction with internal fixation (CRPP), and 3% primary total hip arthroplasty (THA). The remaining 19% of cases were either treated via unspecified procedure of hip repair (9%), managed non-operatively (2%), underwent multiple procedures during the hospital stay (6%), or the surgical procedure data was missing (2%) and were excluded from procedural analyses. The prevalence of MetS was 7.9% and increased among minorities, patients treated at urban hospitals, with comorbidities (heart failure, kidney disease, peripheral vascular disease), and with Medicare coverage. MetS was associated with increased odds of any adverse event (p < 0.0001), specifically: acute renal failure, myocardial infarction, acute posthemorrhagic anemia. MetS was also associated with increased LOS (p < 0.0001) and increased total charges (p < 0.0001). However, MetS was associated with reduced odds of postoperative pneumonia, deep vein thrombosis and pulmonary embolism, surgical site infection, septicemia, and in-hospital mortality (p < 0.0001). The above associations were maintained for MetS patients stratified according to their treatment groups: HA, CRPP, and ORIF., Conclusions: MetS is associated with increased odds of complications in hip fracture patients but decreased odds of in-hospital mortality. This may be related to patients' nutritional status and catabolic states in the perioperative period., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Purpose: To assess the prevalence of subretinal drusenoid deposits (SDD) in older adults with healthy maculas and early and intermediate age-related macular degeneration (AMD) using multimodal imaging., Design: Cross-sectional study., Participants: A total of 651 subjects aged ≥60 years enrolled in the Alabama Study of Early Age-Related Macular Degeneration from primary care ophthalmology clinics., Methods: Subjects were imaged using spectral domain optical coherence tomography (SD OCT) of the macula and optic nerve head (ONH), infrared reflectance, fundus autofluorescence, and color fundus photographs (CFP). Eyes were assessed for AMD presence and severity using the Age-Related Eye Disease Study (AREDS) 9-step scale. Criteria for SDD presence were identification on ≥1 en face modality plus SD OCT or on ≥2 en face modalities if absent on SD OCT. Subretinal drusenoid deposits were considered present at the person level if present in 1 or both eyes., Main Outcome Measures: Prevalence of SDD in participants with and without AMD., Results: Overall prevalence of SDD was 32% (197/611), with 62% (122/197) affected in both eyes. Persons with SDD were older than those without SDD (70.6 vs. 68.7 years, P = 0.0002). Prevalence of SDD was 23% in subjects without AMD and 52% in subjects with AMD (P < 0.0001). Among those with early and intermediate AMD, SDD prevalence was 49% and 79%, respectively. After age adjustment, those with SDD were 3.4 times more likely to have AMD than those without SDD (95% confidence interval, 2.3-4.9). By using CFP only for SDD detection per the AREDS protocol, prevalence of SDD was 2% (12/610). Of persons with SDD detected by SD OCT and confirmed by at least 1 en face modality, 47% (89/190) were detected exclusively on the ONH SD OCT volume., Conclusions: Subretinal drusenoid deposits are present in approximately one quarter of older adults with healthy maculae and in more than half of persons with early to intermediate AMD, even by stringent criteria. The prevalence of SDD is strongly associated with AMD presence and severity and increases with age, and its retinal topography including peripapillary involvement resembles that of rod photoreceptors. Consensus on SDD detection methods is recommended to advance our knowledge of this lesion and its clinical and biologic significance., (Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To examine whether slowed rod-mediated dark adaptation (DA) in adults with normal macular health at baseline is associated with the incidence of age-related macular degeneration (AMD) 3 years later., Design: Prospective cohort., Participants: Adults aged ≥60 years were recruited from primary care ophthalmology clinics. Both eyes were required to be step 1 (normal) on the Age-Related Eye Disease Study 9-step AMD classification system based on color fundus photographs graded by experienced and masked evaluators., Methods: Rod-mediated DA was assessed at baseline in 1 eye after a photobleach using a computerized dark adaptometer with targets centered at 5° on the inferior vertical meridian. Speed of DA was characterized by the rod-intercept value, with abnormal DA defined as rod-intercept ≥12.3 minutes. Demographic characteristics, best-corrected visual acuity, and smoking status were also assessed. Log-binomial regression was used to calculate unadjusted and adjusted risk ratios (RRs) and associated 95% confidence intervals (CIs) for the association between baseline DA and incident AMD., Main Outcome Measures: Presence of AMD at the 3-year follow-up visit for the eye tested for DA at baseline., Results: Both baseline and follow-up visits were completed by 325 persons (mean age, 67.8 years). At baseline, 263 participants had normal DA with mean rod-intercept of 9.1 (standard deviation [SD], 1.5), and 62 participants had abnormal DA with mean rod-intercept of 15.1 (SD, 4.0). After adjustment for age and smoking, those with abnormal DA in the tested eye at baseline were approximately 2 times more likely to have AMD in that eye (RR, 1.92; 95% CI, 1.03-3.62) by the time of the follow-up visit, compared with those who had normal DA at baseline., Conclusions: Delayed rod-mediated DA in older adults with normal macular health is associated with incident early AMD 3 years later, and thus is a functional biomarker for early disease. The biological relevance of this test is high, because it assesses translocation of vitamin A derivatives across the retinal pigment epithelium and Bruch's membrane, 2 tissues with prominent age- and AMD-related pathology., (Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Objective: To examine the association between glaucoma and motor vehicle collision (MVC) involvement among older drivers, including the role of visual field impairment that may underlie any association found., Design: A retrospective, population-based study., Participants: A sample of 2000 licensed drivers aged ≥70 years who reside in north central Alabama., Methods: At-fault MVC involvement over the 5 years before enrollment was obtained from state records. Three aspects of visual function were measured: habitual binocular distance visual acuity, binocular contrast sensitivity (CS), and the binocular driving visual field constructed from combining the monocular visual fields of each eye. Poisson regression was used to calculate crude and adjusted rate ratios (RRs) and 95% confidence intervals (CIs)., Main Outcomes Measures: At-fault MVC involvement over the 5 years before enrollment., Results: Drivers with glaucoma (n = 206) had a 1.65 times higher MVC rate (95% CI, 1.20-2.28; P = 0.002) compared with those without glaucoma after adjusting for age, and mental status. Among those with glaucoma, drivers with severe visual field loss had higher MVC rates (RR, 2.11; 95% CI, 1.09-4.09; P = 0.027), whereas no association was found among those with impaired visual acuity and CS. When the visual field was subdivided into 6 regions (upper, lower, left, and right visual fields; horizontal and vertical meridians), we found that impairment in the left, upper, or lower visual field was associated with higher MVC rates, and an impaired left visual field showed the highest RR (3.16; P = 0.001) compared with other regions. However, no association was found in deficits in the right side or along the horizontal or vertical meridian., Conclusions: A population-based study suggests that older drivers with glaucoma are more likely to have a history of at-fault MVC involvement than those without glaucoma. Impairment in the driving visual field in drivers with glaucoma seems to have an independent association with at-fault MVC involvement, whereas visual acuity and CS impairments do not., (Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study is to examine the epidemiology of firework-related injuries among an emergency department (ED) nationally representative population of the United States for the years 2000-2010, including whether the type of firework causing the injury is differential by patient demographics and whether the severity of injury is associated with the firework type., Methods: The data analysed in this study was collected from the Consumer Product Safety Commission's (CPSC's) National Electronic Injury Surveillance System (NEISS)., Results: A total of 2812 injuries represented an estimated 97,562 firework-related injuries treated in emergency departments within the United States from 2000 to 2010. The incidence generally decreased over time. With respect to age, the rate was higher for children, with the highest rates being observed for 10-19 year olds (7.28 per 100,000 persons) and 0-9 year olds (5.45 per 100,000 persons). The injury rate was nearly three times higher for males compared to the female counterparts (4.48 vs. 1.57 per 100,000 persons). Females were less likely than males to severely injure themselves with all types of fireworks besides sparklers/novelty devices (OR 1.08, CI 0.26-4.38)., Discussion: The results from this suggest that firework-related injuries have decreased by nearly 30% over the 11-year period between 2000 and 2010. Moreover, there has been a decreasing trend in the type of firework causing injury for every firework type excluding the unspecified firework type. However, adolescents of 10-19 years old had the highest rate of injury for fireworks over the 11-year period. In addition odds of injury are differential by firework type., Conclusion: Understanding the specific types of fireworks may lead to better preventative methods and regulations. Moreover, preventative methods should be taken to reduce the rate of firework-related injuries among U.S. youths [1], and possibly more regulations and enforcement of laws geared towards prohibiting novice use of fireworks., (Published by Elsevier Ltd.)

Objective: To determine the frequency of social networking, the degree of information publicly disclosed, and whether unprofessional content was identified in applicants from the 2010 Residency Match., Background: Medical professionalism is an essential competency for physicians to learn, and information found on social networking sites may be hazardous to the doctor-patient relationship and an institution's public perception. No study has analyzed the social network content of applicants applying for residency., Methods: Online review of social networking Facebook profiles of graduating medical students applying for a residency in orthopedic surgery. Evidence of unprofessional content was based upon Accreditation Council for Graduate Medical Education guidelines. Additional recorded applicant data included as follows: age, United States Medical Licensing Examination part I score, and residency composite score. Relationship between professionalism score and recorded data points was evaluated using an analysis of variance., Results: Nearly half of all applicants, 46% (200/431), had a Facebook profile. The majority of profiles (85%) did not restrict online access to their profile. Unprofessional content was identified in 16% of resident applicant profiles. Variables associated with lower professionalism scores included unmarried relationship status and lower residency composite scores., Conclusion: It is critical for healthcare professionals to recognize both the benefits and risks present with electronic communication and to vigorously protect the content of material allowed to be publically accessed through the Internet., (Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Purpose: Lipofuscin contained in the retinal pigment epithelium (RPE) is the main source of fundus autofluorescence (FAF), the target of an imaging method useful for estimating the progression of geographic atrophy (GA) in clinical trials. To establish a cellular basis for hyperfluorescent GA border zones, histologic autofluorescence (HAF) was measured at defined stages of RPE pathologic progression., Design: Experimental study., Participants and Controls: Ten GA donor eyes (mean age ± standard deviation, 87.1 ± 4.0 years) and 3 age-matched control eyes (mean age ± standard deviation, 84.0 ± 7.2 years) without GA., Methods: The 10-micrometer-thick sections were divided into zones of RPE morphologic features according to an 8-point scale. Any HAF excited by 488 nm light was imaged by laser confocal microscopy. The HAF intensity summed along vertical lines perpendicular to Bruch's membrane at 0.2-μm intervals served as a surrogate for FAF. Intensity profiles in 151 zones were normalized to grade 0 at a standard reference location in each eye. Cross-sectional area, mean, and sum autofluorescence for individual RPE cells were measured (cellular autofluorescence [CAF])., Main Outcome Measures: Statistically significant differences in intensity and localization of HAF and CAF at defined stages of RPE morphologic progression for GA and control eyes., Results: The RPE morphologic features were most abnormal (cell rounding, sloughing, and layering; grade 2) and HAF intensity profiles were highest and most variable immediately adjacent to atrophic areas. Peaks in HAF intensity frequently were associated with vertically superimposed cells. The HAF value that optimally separated reactive RPE was 0.66 standard deviations more than the mean for uninvolved RPE and was associated with a sensitivity of 75.8% and a specificity of 76.3%. When variable cell area was accounted for, neither mean nor sum CAF differed significantly among the RPE pathologic grades., Conclusions: Areas with advanced RPE alterations are most likely to exhibit clinically recognizable patterns of elevated FAF around GA, but may not predict cells about to die, because of vertically superimposed cells and cellular fragments. These data do not support a role for lipofuscin-related cell death and call into question the rationale of treatments targeting lipofuscin., (Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Unlabelled: We examined the impact of an eye health education program for older African Americans on attitudes about eye care and utilization, using a randomized trial design in a community setting. Participants were older African Americans attending activities at senior centers: Ten centers were randomized to an eye health education (InCHARGE) or social-contact control presentation. InCHARGE addressed the importance of annual dilated comprehensive examination and strategies reducing barriers to care. The control presentation was on the importance of physical activity. Outcomes were attitudes about eye care 6 months post event through questionnaire and eye care utilization during 12 months post event through medical record abstraction. At baseline, more than 80% participants in both arms said transportation and finding, communicating, and trusting a doctor were not problematic and agreed that yearly care was important. One-fourth said eye examination cost was problematic; one-half said spectacle cost was problematic. There were no group differences 6 months post event. During the 12 months pre event, the dilated exam rate was similar in the groups (38.3% InCHARGE, 40.8% control) and unchanged during the 12 moiths post event. Results suggest fewer than half of older African Americans received annual dilated eye care. Group-administered eye health education did not increase this rate. Even before the program, they had positive attitudes about care, yet many cited examination and spectacle cost as problematic, which was not mitigated by health education. Evidence-based strategies in a community setting for increasing eye care utilization rate in older African Americans have yet to be identified. Policy changes may be more appropriate avenues for addressing cost., Trial Registration: NCT00591110, www.ClinicalTrials.gov

Background: The population's migration from urban to suburban areas has resulted in a more dispersed population and has increased traffic flow, possibly resulting in longer emergency response times. Although studies have examined the effect of response times on time to definitive care and survival, no study has addressed the possible causes of slowed response time from the point of view of emergency medical services (EMS) first responders., Objectives: To assess the variables most commonly associated with increased emergency response time as described by the opinions and views of EMS first responders., Methods: A total of 500 surveys were sent to randomly selected individuals registered as first responders with the Alabama Department of Public Health, and 112 surveys were returned completed. The survey included questions regarding roadway design, response to emergency calls, in-vehicle technology aimed at decreasing travel time, and public education regarding emergency response., Results: Respondents reported traveling on city streets most often during emergency calls, and encountering traffic more often on interstates and national highways. Traffic congestion, on average, resulted in nearly 10min extra response time. Most agreed that the most effective in-vehicle technology for reducing response time was a pre-emptive green light device; however, very few reported availability of this device in their emergency vehicles. Public education regarding how to react to approaching emergency vehicles was stated as having the greatest potential impact on reducing emergency response time., Conclusion: The results of the survey suggest that the best methods for reducing emergency response times are those that are easy to implement (e.g., public education)., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Development of Haemoglobin-based oxygen carriers (HBOCs) as blood substitutes has reached an impasse due to clinically adverse outcomes attributed to vasoconstriction secondary to nitric oxide (NO) scavenging. Studies suggest haemoglobin exhibits nitrite reductase activity that generates NO and N(2)O(3); harnessing this property may offset NO scavenging. Therefore, the effects of concomitantly infusing sodium nitrite (NaNO(2)) with HBOC-201 were investigated., Methods: Swine underwent uncontrolled liver haemorrhage before receiving up to three 10min 10ml/kg infusions of HBOC-201 (HBOC) with or without concurrent NaNO(2) (5.4μmol/kg [LD NaNO(2)] or 10.8μmol/kg [HD NaNO(2)]) or 6% Hetastarch (HEX) with or without HD NaNO(2) during "prehospital" resuscitation (15, 30 and 45min after injury). Definitive surgical care occurred at 75min; anaesthetic recovery at 120min. Animals were euthanised at 72h., Results: NaNO(2) temporarily reduced systemic and pulmonary blood pressure increases from HBOC in a dose-dependent fashion. There was no significant effect between groups in indices of tissue oxygenation or survival. Adverse clinical signs requiring humane euthanasia occurred with highest frequency after HBOC+HD NaNO(2) (3 of 4 pigs) and HBOC+LD NaNO(2) (2 of 4 pigs). Gross evidence of pulmonary congestion was observed in 5 of 8 swine receiving a HBOC and NaNO(2) combination compared to 1 of 16 swine receiving HBOC alone, HEX alone, or HEX+NaNO(2). Gross lesions correlated with histological evidence of pulmonary oedema and congestion, and in 2 of 4 HBOC+HD NaNO(2) pigs, pulmonary fibrin thrombi also were found. No other pig had similar evidence of thrombi. Asymmetric pre-resuscitation cardiac index was a potential confounder., Conclusions: A significant interaction between NaNO(2) and HBOC-201 ameliorated HBOC-201 vasoconstrictive effects, consistent with HBOC possessing a nitrite reductase activity that generates vasodilator NO equivalents. Results were relatively equivalent in survival and markers of tissue oxygenation. The highest dose of NaNO(2) was the most effective in reducing HBOC-associated pulmonary and systemic vasoactivity but also with the highest incidence of adverse events. In this model, the transient nature of NaNO(2) in off-setting HBOC-201 vasoconstriction makes it less clinically promising than anticipated and the combination of NaNO(2) and HBOC appear to increase the risk of pulmonary complications in a dose-dependent fashion independently of haemodilutional effects on haemostatic components., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Purpose: To evaluate the effects of age and race on optic disc, retinal nerve fiber layer (RNFL), and macular measurements with spectral-domain optical coherence tomography (SD OCT)., Design: Cross-sectional observational study., Participants: Three hundred fifty adult subjects without ocular disease., Methods: Data from SD OCT imaging of the optic nerve head, peripapillary RNFL, and macula of 632 eyes from 350 subjects without ocular disease were imaged with SD OCT. Multivariate models were used to determine the effect of age and race on quantitative measurements of optic disc, RNFL, and macula., Main Outcome Measures: Optic nerve, RNFL, and macular measurements with SD OCT across racial strata and age., Results: For optic nerve parameters, participants of European descent had significantly smaller optic disc area than other groups (P<0.0001), and Indian participants had significantly smaller rim area than other groups (P<0.0001). Indian and Hispanic participants had thicker global RNFL measurements than other groups (P<0.0001). Participants of African descent were associated with thinner inner retinal thickness in the macula (P<0.0001). Age was associated with several parameters, with rim area reducing by 0.005 mm(2)/year, RNFL thickness reducing by 0.18 μm/year, and inner retinal thickness reducing by 0.1 μm/year (P<0.0001 for all age associations)., Conclusions: Optic nerve, RNFL, and macular measurements with SD OCT all varied across racial groups and with age. These differences are important in defining the range of normal variation in differing populations and should be considered in the use of these instruments in the detection of optic nerve and macular disease across these population groups., Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references., (Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Background: Although contrast venography is the standard imaging method for inferior vena cava (IVC) filter insertion, intravascular ultrasound (IVUS) imaging is a safe and effective option that allows for bedside filter placement and is especially advantageous for immobilized critically ill patients by limiting resource use, risk of transportation, and cost. This study reviewed the effectiveness of a prospectively implemented algorithm for IVUS-guided IVC filter placement in this high-risk population., Methods: Current evidence-based guidelines were used to create a clinical decision algorithm for IVUS-guided IVC filter placement in critically ill patients. After a defined lead-in phase to allow dissemination of techniques, the algorithm was prospectively implemented on January 1, 2008. Data were collected for 1 year using accepted reporting standards and a quality assurance review performed based on intent-to-treat at 6, 12, and 18 months., Results: As defined in the prospectively implemented algorithm, 109 patients met criteria for IVUS-directed bedside IVC filter placement. Technical feasibility was 98.1%. Only 2 patients had inadequate IVUS visualization for bedside filter placement and required subsequent placement in the endovascular suite. Technical success, defined as proper deployment in an infrarenal position, was achieved in 104 of the remaining 107 patients (97.2%). The filter was permanent in 21 (19.6%) and retrievable in 86 (80.3%). The single-puncture technique was used in 101 (94.4%), with additional dual access required in 6 (5.6%). Periprocedural complications were rare but included malpositioning requiring retrieval and repositioning in three patients, filter tilt >/=15 degrees in two, and arteriovenous fistula in one. The 30-day mortality rate for the bedside group was 5.5%, with no filter-related deaths., Conclusions: Successful placement of IVC filters using IVUS-guided imaging at the bedside in critically ill patients can be established through an evidence-based prospectively implemented algorithm, thereby limiting the need for transport in this high-risk population., (Copyright (c) 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)

Objective: A substantial increase in the number of nonpowered and powered scooter injuries since 2000 has occurred in the United States. Because of differences in weight and operational speed between scooter types, it is possible that the type and severity of injuries may differ. The purpose of the current study is to compare demographics and injury characteristics between scooter types, focusing on differences in injury severity., Methods: The 2002-2006 National Electronic Injury Surveillance System provided information about individuals aged 2 to 12 years who sought treatment at an emergency department due to powered or nonpowered scooter-related injury in the United States. We defined severe injury as an injury resulting in the hospitalization, staying in the hospital for observation, or transfer of the injured patient. Logistic regression analysis, adjusted for sex, age, and geographic location in which the injury occurred, estimated odds ratios (ORs) and 95% confidence intervals (CI) for the association between scooter type and severe injury., Results: There were an estimated 15 752 and 185 007 injuries related to powered and nonpowered scooters, respectively. Powered scooter-related injuries were over 3 times as likely to be severe (OR 3.57, 95% CI, 1.91-6.65). This association was more prominent among females (OR 5.80, 95% CI, 2.02-16.63) than males (OR 2.90, 95% CI, 1.44-5.82)., Conclusion: Data suggest that, compared with nonpowered scooter-related injuries, powered scooter-related injuries are more often severe. This association is stronger among females than males. The higher risk of severe injury due to powered scooter use could result from increases in concussions and hip and lower extremity injuries.

Older African Americans have higher rates of vision impairment and lower utilization rates of comprehensive eye care, compared to Caucasians. InCHARGE is an eye health education program for this population that promotes prevention through the annual, dilated comprehensive eye examination. This study, using a pre-/postdesign, evaluated whether InCHARGE imparted knowledge about prevention and strategies for reducing barriers to care. The program was presented to 85 older African Americans in 5 senior centers in Montgomery, AL. Changes in attitudes about annual eye care were assessed by a questionnaire before and 3 months after InCHARGE. At baseline, most (> 85%) responded it would not be difficult for them to find an ophthalmologist or optometrist, and the exam cost was not a problem. Twenty-five percent reported problems finding transportation to the doctor and covering the eyeglasses cost. Forty-four percent reported not having an eye exam in the past year; 13% reported not having one within 2 years. Three months after InCHARGE, those who reported that they could find a way to get to the doctor increased (X2 = 3.8, p = 0.04). After InCHARGE, 72% said they either had received or scheduled an eye exam. Responses to a question about what was learned from InCHARGE indicated that the InCHARGE's key messages about comprehensive eye care were successfully imparted to most. This study suggests that older African Americans in the urban south have positive attitudes about eye care, even before an eye health education presentation. Following InCHARGE, they identified transportation problems less frequently as a barrier, indicated that they learned InCHARGE's key message and had plans for seeking routine, preventive eye care. A next step is to verify through medical record review the extent to which the high rates of self-reported eye care utilization reflect behavior.

Background: Early efforts to predict death following severe burns focused on age and burn size; more recent work incorporated inhalation injury and pneumonia. Gender, co-morbid illness, and co-existent trauma have been implicated in burn mortality but have rarely been incorporated into predictive models., Methods: The National Burn Repository (NBR) and the National Trauma Data Bank (NTDB) provided data on 68,661 (54,219 and 14,442, respectively) burn patients that was used to develop and validate, respectively, a predictive model of burn mortality. Logistic regression was used to model the odds of mortality with respect to age, gender, % body surface area burned (BSAB), co-existent trauma, inhalation injury, pneumonia, and co-morbid illness. Performance of the predictive model was assessed using a deviance statistic, receiver operating characteristic (ROC) curves, and the Hosmer-Lemeshow (HL) statistic., Results: The predictive model that demonstrated optimal performance included the variables age, percent total BSAB, inhalation injury, co-existent trauma, and pneumonia. The area under the ROC curve for this model was 0.94 and the HL statistic was 16.0. The inclusion of additional variables, i.e., gender, co-morbid illness, did not improve the performance of the model despite reduction in the model deviance. When the predictive model was applied to the validation data source, the area under the ROC curve was 0.87 and the HL statistic was 10.0, indicating good discrimination and calibration., Conclusion: The results of this study suggest that a comprehensive predictive model of burn mortality incorporating certain variables not previously considered in other models provides superior predictive ability.

Background: Epidemiologic research on intentional burns in the United States has mainly been based on small, geographically restricted populations. The current study presents the descriptive epidemiology of intentional burns using data from a large, geographically diverse population of burn patients., Methods: The National Burn Repository (NBR) was queried for patients with intentional burns and analyzed data pertaining to their demographic and medical characteristics; primarily comparing the prevalence proportions of these variables according to specific injury intent., Results: From a total of 54,219 burn patients, 1601 patients who sustained intentional burns were identified; 49% were self-inflicted, and 51% were assault-related. Compared to all other burn patients, intentional burn patients had a larger mean total body surface area (TBSA) burned (22.0% versus 11.3%, p<0.0001), longer hospital stay (19.8 days versus 12.5 days, p<0.0001), and higher mortality (13.9% versus 2.5%, p<0.0001). Self-inflicted compared to assault-related burns were associated with a larger TBSA burned (27.5% versus 16.8%, p<0.0001) and higher mortality (20.8% versus 7.2%, p<0.0001)., Conclusions: Data from this national cohort of burn patients support findings from smaller studies that patients who suffer intentional burns experience excess morbidity and mortality.

Objective: To examine impairment in cone- versus rod-mediated dark adaptation in the parafovea of persons with age-related maculopathy (ARM)., Design: Cross-sectional., Participants: Older adults with ARM at various severity levels from early to advanced (n = 83) and in good retinal health (n = 43), as determined by stereo fundus photographs evaluated with the Age-Related Eye Disease Study severity scale., Methods: Dark adaptation, both cone- and rod-mediated components, was measured with a modified Humphrey Field Analyzer using a target located 12 degrees in the inferior visual field on the vertical meridian, after exposure to a 98% bleach. Information was collected on self-reported problems for activities at night or under dim illumination (Low Luminance Questionnaire [LLQ]) and for activities during daytime conditions (modified National Eye Institute Visual Function Questionnaire [NEI VFQ])., Main Outcome Measures: Cone- and rod-mediated parameters of dark adaptation., Results: Compared with older adults in normal retinal health, ARM patients had significant impairments in rod-mediated parameters of dark adaptation (rod-cone break, rod slope, rod sensitivity) (P<0.0001), which were increasingly abnormal as disease severity increased. Cone-mediated parameters (cone time constant and cone sensitivity) were not impaired. Low Luminance Questionnaire scores and NEI VFQ scores decreased with increased ARM severity (P = 0.0004 and P = 0.0005, respectively); the percent decrease in LLQ scores as a function of disease severity was larger in magnitude than the percent decrease in NEI VFQ scores., Conclusions: Disturbances in rod-mediated but not cone-mediated dark adaptation in the parafovea at 12 degrees in the inferior field on the vertical meridian are characteristic of ARM even in its early phases.

Purpose: To evaluate the association between cholesterol-lowering medications and age-related macular degeneration (AMD)., Design: Case-control study., Participants: The Atherosclerosis Risk in Communities study is a prospective, population-based, cohort study conducted in 4 communities across the United States. A total of 15792 individuals aged 45 to 65 years were enrolled between 1987 and 1989; fundus photographs were added to the study protocol at the 6-year follow-up (1993-1995). Cases were subjects who were identified as having AMD after applying a standard definition to their fundus photographs; controls did not have AMD., Methods: The use of cholesterol-lowering medications at any time during the study was determined and compared between cases and controls, adjusting for the potentially confounding effect of demographic, behavioral, and medical characteristics., Main Outcome Measures: Presence of AMD and the use of cholesterol-lowering medications., Results: A total of 871 AMD cases and 11,717 controls were identified. Of the AMD cases, 11% made use of cholesterol-lowering medications, as compared with 12.3% of controls (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.71-1.11). Adjusting for the confounding influence of age, gender, and race revealed a statistically significant relationship between AMD and use of cholesterol-lowering medications (OR, 0.79; 95% CI, 0.63-0.99)., Conclusions: The results of this study add to the growing body of evidence that cholesterol-lowering medications may reduce the risk of developing AMD. Additional research is needed to document the mechanism responsible for this association. A clinical trial of the impact of statins on AMD deserves consideration.

Purpose: To determine if differences in optic disc topography exist between blacks and whites independent of racial differences in the area of the scleral canal., Design: Cross-sectional observational study., Participants: A cohort of 146 eyes from black subjects and 97 eyes from white subjects without detectable ocular disease., Methods: Reliable bilateral images were obtained using a retinal topographer. Mean values for all topographic parameters were compared both unadjusted and adjusted for differences in optic disc area and/or reference plane height. Comparisons of group differences for parameters and linear discriminant functions were adjusted for interocular dependence and multiple comparisons., Results: Blacks had a significantly greater optic disc area (mean disc area in right eye: black subjects, 2.14 mm(2); white subjects, 1.96 mm(2) [P = 0.02]; mean disc area in left eye: black subjects, 2.18 mm(2); white subjects, 2.02 mm(2) [P = 0.04]). Most racial differences in optic disc parameters were not significant after adjustment for differences in optic disc area and reference plane height. However, eyes of black subjects demonstrated a deeper maximum cup depth than those of whites (P = 0.004), independent of differences in disc area and reference plane height. The values of linear discriminant functions did not differ significantly between racial groups, and the Moorfield classification correctly identified a similar proportion of subjects as normal in each racial group., Conclusions: Most of the normal variation in optic disc topography between blacks and whites seen with a retinal topographer is due to either differences in disc area or differences in reference plane height. However, small residual differences remain in cup depth independent of these parameters. These racial differences in optic disc structure should be considered in the statistical judgment of disease status based on these parameters. The Moorfield classification, which takes disc area into account, performed with similar specificity in each racial group.

Purpose: To examine the impact of depression in older adults on responses to the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) independent of demographics, vision, and general health., Design: Cross-sectional., Participants: We took the opportunity of an ongoing study on older drivers to address the specific aim stated above. The recruitment population consisted of 6342 older adults (> or =60 years) who were licensed drivers residing in Birmingham, Alabama; who had been involved in a crash in the prior year, as identified by Alabama Department of Public Safety records; and whose phone numbers could be located. Additional eligibility criteria were visual acuity impairment, slowed visual processing speed, or both, and a Mini-Mental State Examination score of > or =23. Persons in the recruitment population who met these eligibility criteria and agreed to enroll in a study on driver safety (purpose of the main study) numbered 403., Methods: The following questionnaires were interviewer administered in person and scored per standard procedures: the NEI VFQ-25, the Center for Epidemiological Studies Depression Scale (CES-D), a general health questionnaire, and a review of demographic information. Depressed persons were defined as those with CES-D scores of > or =16. There were complete data on 397 persons., Main Outcome Measure: Reduced score on the NEI VFQ-25 (defined by a score of <87.5) on the total questionnaire and 12 subscales., Results: After adjusting for demographics, vision, mental status, and general health, depression was significantly associated with a reduced NEI VFQ-25 score for total score and the subscales of distance vision, peripheral vision, role difficulties, dependencies, and mental health. Odds ratio point estimates in these adjusted associations ranged from 2.9 to 4.6., Conclusions: The results imply that older persons who are depressed may have reduced scores on the NEI VFQ-25 independent of the impact of vision problems. Depression in the elderly could be influencing their self-perception of the burden of eye disease and treatment effectiveness in clinical and epidemiologic studies.

Purpose: To determine if hypothyroidism is associated with an increased risk of glaucoma using a large cohort of patients., Design: Nested case-control study., Participants: Patients seen at the Veterans Affairs Medical Center in Birmingham, Alabama with newly diagnosed glaucoma between 1997 and 2001 were selected (n = 590) and age-matched to nonglaucoma controls (n = 5897)., Methods: Patient information was extracted from the Birmingham Veterans Affairs Medical Center data files containing demographic, clinical, and medication information. An index date was assigned to the glaucoma subjects corresponding to the time of diagnosis. Patients who had a glaucoma diagnosis before the observation period of the study were excluded. Ten controls were randomly selected for each patient and matched on age (+/-1 year) and an encounter on or before the index date of the matched case., Main Outcome Measures: Odds ratios (ORs) for the association between the prior diagnosis of hypothyroidism and the risk of developing glaucoma with adjustment for the presence of diabetes, lipid metabolism disorders, hypertension, cardiovascular disease, cerebrovascular disease, arterial disease, and migraines., Results: After adjustment for the other potential risk factors, patients were significantly more likely to have prior hypothyroidism than controls (OR, 1.40; 95% confidence interval, 1.01-1.97)., Conclusions: Our study has demonstrated a significantly greater risk of subjects with a preexisting diagnosis of hypothyroidism developing glaucoma, compared with controls, in a large Veterans Affairs Medical Center population.

Recently, there has been an awareness of the variable phenotypic expression of numerous disorders between individuals from different ethnicities, systemic lupus erythematosus (SLE) one of them. These disparities probably arise from the interaction between genetic and non-genetic (environmental, socioeconomic-demographic, cultural and behavioral) factors. To delineate the influence of these factors on SLE outcome, we established a multiethnic (Hispanic, African American and Caucasian) United States (US) early cohort (<5 years disease duration). Ten years later, interesting data have emerged from the LUMINA (Lupus in Minorities: Nature vs. nurture) cohort. For example, African Americans and Hispanics from Texas have a more severe disease than Caucasians and Hispanics from Puerto Rico. Lack of private insurance, acute SLE onset, expression of HLA-DRB1*01 (DR1) and C4A*3 alleles were associated with higher disease activity, whereas age, the number of American College of Rheumatology criteria met, disease activity, corticosteroid use and abnormal illness behaviors were consistent predictors of damage. In turn, damage and poverty were found to predict mortality. We now plan to apply new approaches (genetic admixture) to deconfound the complex interaction between genetic and non-genetic factors influencing SLE outcome. These data may have impact on the development of policies aimed at eliminating health disparities in the US.

Purpose: To evaluate the efficacy and safety of arteriovenous sheathotomy surgery to decompress branch retinal vein occlusion (BRVO)., Design: Prospective, nonrandomized, comparative interventional trial with concurrent control group., Participants: Twenty eyes with decreased visual acuity secondary to BRVO who underwent vitrectomy and surgical decompression by means of arteriovenous sheathotomy were compared with 20 control eyes (10 observation and 10 laser treated)., Intervention: The 20 surgical eyes underwent pars plana vitrectomy and arteriovenous sheathotomy with a microvitreoretinal blade. Of the 20 control eyes, 10 had no intervention (observation), and 10 had grid laser photocoagulation a mean of 9 months after diagnosis., Results: The mean preoperative visual acuity was 20/250 in the surgical group and 20/180 in the control group (statistically similar in the observation group and laser-treated group). The mean 14-month visual acuity was 20/63 in the surgical group and 20/125 in the control group (P = 0.02). Seventy-five percent of the surgical group halved their visual angle compared with 40% of the control group (40% observation vs. 40% laser; P = 0.025). Average lines of visual acuity gained were 4.55 in the surgical group and 1.55 in the control group (P = 0.0226; 1.1 lines in observation group and 2.0 lines in laser group)., Conclusions: Surgical arteriovenous sheathotomy to decompress BRVO results in significantly better visual outcomes than a matched control group of observation and laser-treated eyes. A randomized multicenter clinical trial is warranted to determine the efficacy of this procedure.

Study Objectives: Inhalation of harmful substances is common in the workplace. The purpose of this study was to describe the epidemiology of fatal occupational inhalations in the United States., Design: Data from the Census of Fatal Occupational Injuries from 1992 to 1998 were analyzed. Information on demographic characteristics, occupation, and industry was used to calculate specific mortality rates, and the inhaled substances were identified., Results: Nationwide, there were 523 cases of fatal occupational inhalation, with a mortality rate of 0.56 deaths per 1,000,000 worker-years. The rate of death was greater for men (1.01/1,000,000) than for women (0.03/1,000,000), and workers > or = 65 years of age had the highest mortality. Mining was the industry with the highest mortality rate (6.64/1,000,000). The occupations with the highest rate were firefighters (3.54/1,000,000) and farming, forestry, and fishing occupations (2.84/1,000,000). Nearly half of the inhalation victims were constructing, repairing, cleaning, inspecting, or painting when the injury occurred. Overall, carbon monoxide was the most frequently inhaled substance (33.5%). The incidence of fatal carbon monoxide inhalations was twice as high in the winter as in the summer. The proportion of workers killed by carbon monoxide poisoning increased with increasing age., Conclusions: Work-related inhalations cause more deaths than any other mode of exposure to harmful substances. Recognizing those circumstances that pose a higher risk for maintenance and repair workers, as well as upgrading carbon monoxide poisoning prevention programs, could have a major impact in reducing fatal work-related inhalation injuries.